Provider Demographics
NPI:1417737891
Name:JABATEH, AMARA (MANAGER/CO-OWNER)
Entity Type:Individual
Prefix:
First Name:AMARA
Middle Name:
Last Name:JABATEH
Suffix:
Gender:M
Credentials:MANAGER/CO-OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10145 W CORDES RD
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8443
Mailing Address - Country:US
Mailing Address - Phone:602-477-9735
Mailing Address - Fax:
Practice Address - Street 1:10145 W CORDES RD
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-8443
Practice Address - Country:US
Practice Address - Phone:602-477-9735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLH111902083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine